A Physical Therapist’s Guide to Pain-Free Hiking

Protect your knees, ankles, back, and hips with these tips and tricks
By Ben Wobker, PT, MSPT, CSCS, SFMAc
A Physical Therapist’s Guide to Pain-Free Hiking

Ah, hiking. Whether you’re trekking up a rocky mountain path or exploring forest trails, nothing beats the challenge of a good climb. To keep your body in tip-top shape and prevent injury, preparation is key. 

You’ll especially want to protect your knees and other joints from the bumps and jolts that are a part of any hike. Otherwise, you may find your summer adventures sidelined by injuries or pain in your knees, back, hips, or ankles. This is where an investment in the right hiking gear can make all the difference.

Trekking Poles

To ease knee symptoms and keep your joints healthy, start with a good pair of fixed or collapsible trekking poles. They will:

  • Reduce the load to the knee by offsetting force through the upper body and core.
  • Improve balance and stability particularly when going downhill.
  • Improve forward lean when going uphill by involving the back extensors, glutes, and upper body.

For maximum benefit, be sure to hold the hiking poles as close to a 90-degree angle to your elbow as possible—you  may have to adjust as the terrain changes. Typically, you’ll want to shorten the poles for uphill treks and lengthen them when going downhill. Hold the handles as though they were ski poles, and keep a light grip.


There are almost as many backpacks as there are hikes. Selecting the right one for you depends on several factors:

  • Capacity: The size of the backpack you'll need depends on the length of your trip and how much weight and bulk you want to carry. Typically, 15 to 20 pounds is plenty for a day hike.
  • Volume: Again, this is tied to how long you’ll be hiking. For a weekend trip—one to three nights—consider a 30- to 50-liter backpack. For longer treks—three to five nights—a 50- to 80- liter pack is ideal. Extended trips lasting five nights or longer require a pack of 70 liters or larger.
  • Frame types: Body-hugging internal frames are designed to keep a hiker stable on uneven, off-trail terrain. They may incorporate a variety of load-support technologies that transfer the load to the hips—excellent for your back and shoulders. An external-frame backpack works if you’re carrying a heavy, irregular load such as an inflatable kayak. They also offer good ventilation and options for organizing your gear. 
  • Fit: Remember that torso length, not your height, is most important for an appropriate fit. matters most.
  • Features: These refinements affect how the pack works for you, such as chest strap, metal stays, and waist belt.

Hydration Equipment

Wherever you go and whatever you do, don’t forget water. How much you need depends on your type of activity, intensity level, duration, weather, your age, your sweat rate, and your body type. A good general recommendation is about a one-half liter of water per hour of moderate activity in moderate temperatures. 

Your activity will also determine where you stow your water— the key is to keep it handy! For hiking, backpacking, and mountain biking, a hydration reservoir is an excellent option. If you prefer to use a bottle, stash it somewhere accessible, like a mesh pocket that’s on the side of many backpacks.

Is Injury Inevitable?

Despite all your precautions, you may end up getting hurt. A common injury is patellofemoral pain syndrome (PFPS), also called runner’s knee. It’s not a specific injury—it’s a broad term for describing the pain that comes from one of several knee problems. You’ll usually notice the pain in front of your kneecap, but it can be felt around or behind it. You might also have swelling, hear popping, or have a grinding feeling in the knee.

You can treat runner’s knee and tame symptoms by resting your knee, addressing cadence (steps per minute), icing it, wrapping it, or elevating your leg. Stretching and strengthening exercises for your quadriceps, glutes, hamstrings, and similar muscles can be especially helpful.

Treatment from a reputable physical therapist can ease pain and help you heal. Your PT can also provide strengthening exercises that prevent injury down the road—or hiking trail!